后路寰椎有限内固定治疗寰椎不稳定性骨折

Posterior atlas limited internal fixation for atlas unstable fractures

中文关键词:  寰椎骨折  内固定  疗效

英文关键词:Atlas fractures  Internal fixation  Outcome

中文摘要:

  【摘要】 目的：探讨后路寰椎钉棒系统有限内固定治疗寰椎不稳定性骨折的疗效。方法：2008年4月~2010年10月采用后路寰椎钉棒系统内固定治疗寰椎不稳定性骨折10例，男7例，女3例；年龄20~60岁，平均37.5岁。患者均有不同程度的枕颈部疼痛、僵硬和颈部活动受限，均无神经损伤表现。双侧寰椎后弓并单侧寰椎前弓骨折（后3/4 Jefferson骨折，Landells Ⅱ型）6例，单侧寰椎前后弓骨折（半环Jefferson骨折，Landells Ⅱ型）4例；横韧带完整7例，横韧带附着处骨折和撕脱（Dickman Ⅱ型）3例。术前均行颅骨牵引稳定骨折块。结果：共置入螺钉20枚，其中1例在置入寰椎椎弓根螺钉时后弓破裂，1例术前进钉点处后弓破裂，直接将螺钉固定在侧块上；1例患者寰椎后弓进钉点处的高度小于4mm，无法行椎弓根螺钉固定而改为侧块螺钉固定；其余7例均行寰椎椎弓根螺钉固定。手术时间为60~90min，平均70.5min；术中出血量为100~300ml，平均150ml。术中1例患者在剥离寰椎后弓下缘时损伤静脉丛，用明胶海绵压迫止血；未发生脊髓和椎动脉损伤。术后X线片及CT示1例一侧寰椎椎弓根螺钉部分进入椎动脉孔，1例一侧螺钉偏内致椎弓根内侧皮质破裂，但均无血管神经损伤症状，未处理；其余螺钉位置良好。随访12~36个月，平均20.2个月，术后3~6个月枕颈部疼痛缓解，颈部活动范围基本接近伤前水平；术后6个月复查骨折断端达到骨性融合；随访期间颈椎序列良好，未见内固定松动、断裂，无C1-2失稳。结论：在严格选择适应证的前提下，寰椎后路钉棒系统有限内固定是治疗寰椎不稳定性骨折的较好方法，能保留枕颈部活动功能。

英文摘要:

  【Abstract】 Objectives: To investigate the surgical outcomes of posterior C1 screw-rod system for C1 unstable fractures． Methods: From April 2008 to October 2010, 10 patients with C1 unstable fractures underwent posterior C1 screw-rod system. There were 7 males and 3 females with the average age of 37.5 years(range, 20-60 years). All patients complained of neck pain, stiffness, and decreased range of motion without neurologic deficit． Six patients had bilateral posterior arch fractures associated with unilateral anterior arch fractures(posterior 3/4 Jefferson fracture, Landells type Ⅱ), and four had unilateral anterior and posterior arch fractures(half-ring Jefferson fracture, Landells type Ⅱ). Seven patients had intact transverse ligament, and three patients had fractures and avulsion of the attachment of transverse ligament(Dickman type Ⅱ)． Preoperative skull traction was used routinely. Results: A total of 20 screws were inserted safely. 3 cases had pedicle screw placed in lateral mass due to posterior arch breakage in 1 case, entry point breakage in 1 case , and the height of posterior arch at the entry point less than 4mm in 1 case. The remaining 7 cases had screw placed in pedicle. The operative time was 60-90min, with a mean of 70.5min, and the intraoperative blood loss ranged from 100-300ml, with a mean of 150ml. 1 case was complicated with veiniplex injury with no heavy blood loss due to successful hemostasia． No spinal cord or vertebral artery injury during surgery was noted. Postoperative roentgenograph and CT scan showed transverse foramen penetration in 1 case, and breakage of medial wall of spinal canal in 1 case, but no neurovascular injury was noted．The remaining screws were in good position. All patients were followed up for 12-36 months, with a mean of 20.2 months． All cases were completely painfree and had full range of motion of the cervical spine 3-6 months later after surgery. Bony fusion was achieved 6 months later. During the follow-up period, good cervical alignment was maintained with no instrument failure and C1-2 recurrent instability. Conclusions： In the premise of strictly select surgical indications, posterior C1 screw-rod fixation system is a better way for treatment of C1 unstable fractures, which can preserve the function of the craniocervical junction.